Editor's Note

Editor's Note

The In-Session Breakthrough Fantasy

Therapists have always loved stories about dramatic in-session breakthroughs, those rare times when clients unexpectedly experience what seem like epiphanies—sudden insights about themselves and their lives, after which nothing will ever be the same for them. This kind of transformative moment can make the slow, painful slog of therapy feel worthwhile, and it’s a welcome counterbalance to the frustrations of a difficult, underpaid, underappreciated vocation. As a teary-eyed, beaming client waves a grateful good-bye, “That,” we can say, “is why we do therapy!” . . . Or so the fantasy goes.

The idea that such breakthroughs really happen, or that they mean very much, has taken a beating over the past few decades. The cognitive-behavioral tradition, in particular, has represented a standing reproach to this kind of romanticism. Therapy, any sensible person knows, is about the steady acquisition of cognitive skills that help clients override their self-destructive thoughts and runaway emotions. Change happens as a result of setting reasonable goals and engaging in the dogged practice of good thinking habits—-10,000 reps of a certain kind of self-talk, for example, so you can walk into a subway car without freaking out. The idea that the therapist can somehow flip a switch and evoke a kind of psychological rebirth smacks of New Age gurus who practice woo-woo tactics.

Or does it? At the moment, there seems to be something of an enthusiastic revival of the idea that sudden, remarkable breakthroughs—-to use the b-word—-can occur during therapy, and that significant change can happen in a remarkably short time. Part of the evidence for this new–old idea is emerging from brain science. After all, what new thinking about therapy doesn’t have at least one foot in neuroscience? The more we learn about neuroscience, the more we realize that human beings aren’t driven by our ability to analyze and cogitate about our lives. Instead, we’re moved by our viscerally immediate, bottom-up responses to events and relationships. Our memories, our sense of ourselves, our plans and desires, the way we interpret what happens to us, even our ability to think logically are all basically propelled by our emotional responses to lived experience. The key word here is experience. In other words, as a growing body of research shows, deep change doesn’t come when clients just talk about their problems: it results from the impact of an emotionally arousing therapeutic experience on the structures and biochemistry of the brain.

What this may mean for clinical practice—-and what we investigate in this issue—-is the idea that breakthroughs can and do happen, but only if the therapist can create an attention-riveting, visceral emotional experience in session. This isn’t exactly your grandfather’s talk therapy, in which reason had its triumphant way with emotion—-but just the reverse.

Therapists have always known that good therapy is far from a bloodless, abstract discussion about the client’s issues. If treatment works, the client must feel it at the center of his or her being. But not until now have we had such scientific support for the idea that effective therapy must give clients something more than kindly, supportive, empathic conversation. It has to provide an utterly compelling emotional experience. Or as that famous 1960s therapeutic visionary Mama Cass sang (as quoted by author Courtney Armstrong in this issue), “Words of love, so soft and tender won’t win a girl’s heart anymore. If you love her, then you must send her somewhere where she’s never been before.”